The effect of proton-pump inhibitors on development of arrhythmia and hypomagnesaemia after off-pump coronary artery bypass surgery

Long-term use of proton-pump inhibitors (PPI) can result in hypomagnesaemia and arrhythmia.The aim of this study was to compare the effect of PPI and histamine 2-receptor antagonists (H2RA) on the incidence of hypomagnesaemia and arrhythmia in patients following off-pump coronary artery bypass surgery (CABG). In this randomized-controlled clinical trial 290 patients admitted ICU after off-pump CABG were randomly divided into two groups of H2RA (n=145) and PPI (n=145).For patients in the H2RA group, 50 mg intravenous ranitidine was prescribed every 8hrs after during the nothing by mouth (NPO) period followed by 40mg famotidine tablet after starting the oral regimen (PO). The PPI group received 40 mg pantozol IV injections every 12 hrs during the NPO period and 40mg pantozol tablets once daily after becoming PO.The patients were investigated for development of hypomagnesaemia and associated arrhythmia. In total 271 patients with the mean age of 59.3±10 yrs completed the study (female/male=32.8%). Hypomagnesaemia occurred in 60.1% of the patients; 76 (56.7%) in the H2RA group and 87 (63.5%) in the PPI group (P=0.245) whereas arrhythmia had a prevalence of 12 (9.6%) and 15 (11.1%), respectively (P=0.690). The mean time of occurrence of hypomagnesaemia and arrhythmia were 1.75±1.08 and 3.0±0.9 days after the operation in the H2RA group and 1.47±0.7 and 2.9±1.5 days in the PPI group, respectively (P=0.111 and P=0.897). Our study revealed that the short-term use of PPIs does not result in higher rates of hypomagnesaemia and associated arrhythmia in comparison to H2RAs after off-pump CABG.